title: Systemic and local cytokine kinetics in musculoskeletal injury: a prospective study in patients with ankylosing spondylitis.
abstract: OBJECTIVE
  Back surgery in patients with ankylosing spondylitis is a major trauma in individuals with tissue inflammation and joint destruction along the spine; we used surgery in these patients as a model in the study of systemic and local cytokine profiles in complicated trauma situations.
  
  
  METHODS
  Blood was sampled before, during and after surgery in 10 patients operated on with extending osteotomy of the lumbar spine. Samples of arterial blood and local wound blood were analysed for proinflammatory and anti-inflammatory cytokines.
  
  
  RESULTS
  Surgery induced no significant changes in systemic values of TNFalpha and IL-1beta. There were significant increments in systemic values of IL-6, IL-8 and sTNF-R1. A systemic increase in values of IL-10 was only noticed after 24 h. There were increments in local values of TNFalpha at 24 h and in local values of IL-1beta, IL-6, Il-8 and IL-10 at both 4 and 24 h postoperatively. The local values were in general significantly higher than the systemic values.
  
  
  CONCLUSIONS
  This study indicates that a major musculoskeletal trauma principally is followed by significant increases in systemic levels of IL-6 with only modest systemic reactions in TNFalpha and IL-1beta, even in patients with an inflammatory disease. However, there are in general significantly increased local levels of IL-1beta, IL-6, IL-8 and IL-10, and our conclusion is that systemic cytokine levels might not reflect local reactions.
authors.affiliation: Department of Orthopedics, Rikshospitalet University Clinic, University of Oslo, Oslo, Norway. olav.reikeras@rikshospitalet.no
authors.forename: O
authors.initials: O
authors.lastname: Reikerås
authors.forename: A
authors.initials: A
authors.lastname: Helle
authors.forename: C D
authors.initials: CD
authors.lastname: Krohn
authors.forename: J I
authors.initials: JI
authors.lastname: Brox
mesh_terms: D016207:Cytokines / Q000097:blood*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D011446:Prospective Studies; D013167:Spondylitis, Ankylosing / Q000097:blood*
chemical_list: D016207:Cytokines; D018836:Inflammation Mediators